Provider Demographics
NPI:1235494212
Name:HUDSON, MARY ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1905 E HUEBBE PKWY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:700 COLLEGE STREET
Practice Address - Street 2:BELOIT COLLEGE
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-363-2000
Practice Address - Fax:614-457-5982
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA13469-NP363LP0200X
WI5600-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics